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FOR OFFICE USE: Permit No. __..f.----•-•----•-• - ----------------"----- -------------- APPLICATION FOR SANITATION PERMIT ------- ---------- --------------------------------- (Complete in Duplicate) Date issued ---------------- " - -------"----------------- This Permit Expire; 1 Year From Date issued k --------------------------- ---I--- l: Application is hereby made to the San Joaquin Local HealthceDiNoG f or a permit to construct and install the work herein described. This application is made in compliance with County Ordinance JOB ADDRESS AND LOCATION____ ---T ry''�--`�-=w' g" -----__:Y P ----- ----------- 'CG i Owner's Name .. t �, . , r� � .= - .� 1 Address; JGj - Phone_::_--- _ = ..... -Confractor's• Name_.--�•T==------------------------------- Motel ❑ Other ❑ - i Installation will serve: Residence [Apartment House ❑.¢,Commercial ❑ Trailer Court ,:!__ Number f baths � Lot size __------- - e� Number ofliving units: _"J___- Number of bedrooms - Depth to Water Table ______.- ft. Public stem ❑ Community system ❑ Private Dep Water Supply: Pu Y � Cla Loam ❑ Clay Adobe❑ Hardpan ❑ Characi�er of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Y FNA/ No ❑ } No ❑ New Construction: Yes ❑ No ❑ VA: Yes ❑ Previous Application Made: {lf yes;date-------------------- TYPE OF INVALLATiON AND SPECIFICATIONS: (No septic tank or cesspool permitted if public rsewer is available within 200 feet. ` r y f q! r � ----- ---- a aria----- Septic ank: Distance�frominearest wel4_.-aZ�_._--Distance from foundation___ -- Capacity l p Size_ 11 Liquid depth �1� p Y No. of com artments_- _---•-- "ft' �4-�i--:Distance from foundation_.__f0--------Distance to nearest lot line_________________ i Dis os Field: Distance from nearest well._.__ ---- p f p -r"Dis th of each kine Width of trench-------- ---------------- -i- Nu4er.of lines----------------- =--- ------ g Type of filter material_____��- ----'-Depth of filter matersal_____l---r--�--F----Total length-----/ ----------------- Yp r } r Seepa a Pit: . Distance to"nearest well__��-�------mDteael Distance oundSizenDiame�r_ .-pan to De nearest lot.ine----------------- 3 Number of pits___.___I _ -Lining Distance fromF nearest^well_____.___-___.._Distance from foundation------_-------- --Lining materia----------------- ------------ ------------------------------------ IN - Cesspool: -Liquid Capacity__-__.-.- gals. .{ ❑ Size: Diameter, ----------=-------------------------Depth._.. Distance from nearesf well---------------- ------- --N�--- D}stanc-- from nearest buil --- --- ----------- Privy: - ----- "-------------------------------- Distance ----- ----- - ❑ Distance to.nearest lot line--------------�_--------------------------- ------- ' ' -------•- -~ =-------- Remodelin 'b ------------------------ ---------------•--------- ------------------- ---------- - •-------•--•---------------- �. . ._ ------- ------------ - ty ----------------•-------- ---—:--------- - done I hereby certify that I have prepared this ap oli ttii n and that the San Joaquin Local�Heal Health accordance with San Joaquin Coun i ordinances, State s, and rules, and regul and/or Contractor) __---�___.____.__ --`I (Signed) f - (T'}1 --------------------- ------- ------- ---- ------ BY (plot plan, sh wing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). "FOR DEPARTMENT USE ONLY DATE------3- APPLICATION ACCEPTED 8Y � ------•--- DATE------------------------------------------------------------ --------------- ----- - ------------------------- REVIEWED BY----------------------------------------- ------------ ------------------- ------------------------- - DAT --------------------------•- - - BUILDINGPERMIT ISSUED------- -------------------------------------------------------------• ---- -------------------------------------------- ------------ ----- ---------------=-------- + Al+era}ions and/or recommendations:-------.................. ___---.----------- ---------------- ---------------------- -. ---- ION Date---- -- G�` - FINAL INSPECT SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 4th Street 300 West Oak Street Tracy,California %]601 E.Hazelton Ave. Lodi,California Manteca,California Stockton,confornia 124 Sycamore Street :VI560 B-59 31A 3-'63 F.P.Cd. f